Many people are confused about “treatment”. Does it mean going to a rehab centre? Is it just for people who have major problems with drugs or alcohol, or people who are addicted? Is it only for people who want to quit altogether? Can a person get better without treatment?
This information sheet is designed to provide information to people who are thinking about treatment. It is meant to answer their questions and help them find the supports they need. For some people, self-help resources like the Problem Substance Use Workbook may be enough to help them make the changes they need. The workbook can be found on the Here to Help website. Other people will want to access professional services in their communities or elsewhere.
Substance-use treatment can be defined as any intervention that helps a person deal with the physical and psychosocial problems related to substance use. These problems might be mild or severe and might relate to their own substance use or that of someone else. Treatment is not about curing a person of their substance-related problems. Rather, it is about providing supportive care to the individual who is ultimately responsible for creating and maintaining the positive change needed in their lives.
When people seek to address problems related to their own substance use, we sometimes say they are seeking recovery. Some people use “recovery” to refer to a lifestyle that involves complete abstinence from alcohol or other drugs. More recently the term has been defined as a personal process of tackling the negative impacts of mental-health or substance-use problems. It involves personal development and change. The process includes:
Acceptance that there are problems to face
The development of a sense of involvement in and control over one’s life
The cultivation of hope
Using support from others
Used in this sense, “recovery” encourages people to see themselves as an integral part of the healing process. It discourages the disempowering view that they are passive recipients of professional interventions. Recovery is often linked to self-management and the act of taking control of one’s own life. In this context, treatment is seen as supporting recovery management. Within the recovery management framework, the service provider assists the person seeking help to reach their own goals, and to help themselves. Successful recovery processes help people identify and appreciate personal and social assets that can help them to live healthier and more fulfilling lives.
With the recovery management approach, time-limited interventions (such as residential treatment or out-patient counselling) are seen as just one part of a larger, comprehensive response. In other words, recovery management is seen as a longer-term developmental process designed to enhance the client’s capacity to create and sustain positive change in their own life.
This means that the starting point for recovery varies depending on each person’s situation. Some people are able to participate in and direct themselves toward wellness from the beginning. But other people may need a lot of direction and support as they get started. However, since the longer-term goal is self-management, the need for external guidance and support should lessen over time as people become capable of more self direction.
In order to help a person who is having problems related to substance use, the factors that contribute to problem use must be understood and dealt with. Many people use substances without harmful effects, but others develop problems ranging from mild to severe.
Substance-use problems are no longer linked with moral or character weaknesses in individuals, as they were in the past. It is now widely accepted that such problems develop from the interaction of several factors. These include physical, psychological and social or environmental factors. Based on this accepted belief, social learning theory provides a useful framework for supporting successful recovery management.
What is social learning theory?
Social learning theory focuses on the role of cognitive, emotional and social or environmental influences on behaviour. Interventions based on this approach start by finding the factors that contribute to a person’s substance-related problems. Then they actively promote healthier ways of thinking, feeling and behaving.
What is the best way to promote healing and recovery?
Three conditions enhance the recovery process: hope, care and empowerment.
Hope. Hopelessness is both a cause and a result of harmful substance-use. Imparting realistic hope is a crucial part of the recovery process because it helps create positive expectations. Positive expectations are important for two reasons. First, they increase a person’s motivation to proactively engage in the often difficult processes necessary for personal change. And second, they can bring about therapeutic effects based on powerful but poorly understood interactions between the mind, body and emotions.
Care. Providing supportive care is also a central part of the recovery process. Genuine caring is a large part of the “therapeutic alliance” that can develop between clients and service providers. Research suggests that this is one of the most important factors for successful recovery outcomes.
A key aspect of care is acceptance. Service providers who have mastered the art of providing supportive care are capable of offering unconditional acceptance to those experiencing problems with substance use. This “radical grace” is essential to the healing process. Many people who experience substance-related problems hold a lot of shame inside. Because of this, even minor or underlying judgements held by service providers are interpreted as blame. Anything that triggers this shame may push them toward denial instead of toward the healthy forms of honest introspection that are necessary to the recovery process.
Empowerment. Since enabling a process of self-directed change is the overall goal, support that is provided to a person should be empowering rather than disempowering. That is, in every instance the support should focus on imparting understandings and skills that increase the person’s ability to self-manage their own recovery process over time.
It is well understood that on-going stress is one of the most important factors leading people to take part in harmful substance use. Many people regularly use alcohol and drugs to cope with stress. The loss of a sense of personal control is one of the most common sources of stress in modern life. For example, people who have less personal control over the work they do often report higher levels of stress than those who have significant influence over the direction and, especially, the pace of their work. Promoting self-management and creating a greater sense of personal control can help ease a potent source of stress. This, in turn, reduces the need to engage in risky or harmful substance-use as a way to cope with life.
The following are recommendations made by a panel of international experts regarding effective treatment for harmful substance use.
What are the goals of treatment?
In discussing goals, we must distinguish between the goals for the individual and the goals for the community or society.
For some time, treatment experts believed that real change in people’s lives could only happen after abstinence was achieved. They believed that once focus shifted away from the use of substances, people could then be supported to rebuild their lives.
Recovery management has radically changed this idea. For some experts, abstinence is still the preferred ultimate goal. However, for many people abstinence may not be immediately realistic, especially at the start of treatment. At the individual level, the goal of treatment should always be to help the individual take control of their own life. In essence, this turns the traditional perspective on its head. It used to be believed that a person needed to get off drugs to get their life together. From the recovery management perspective, we now understand that people often need to get their lives together in order to get off drugs. The path of recovery is varied and evidence suggests that treatment goals need to be individualized and grounded in the real-life circumstances of the person.
From a community perspective the goal of treatment may be to reduce crime or health-care costs, or to improve the social environment.
Being conscious of both the individual and community goals for substance-use treatment, the addiction services system in BC has adopted harm reduction as a foundational guiding principle. This means that services are guided by the aim of minimizing harm to both individuals and communities. One advantage of this approach is that degrees of success can be measured in terms of harms diminished. In keeping with this view, the system recognizes that a single approach to treatment cannot fit needs of all individuals with problems related to substance use. The same applies to communities that are impacted by substance use.
People experiencing harms related to substance use can benefit from a variety of services and supports. These maybe provided through a range of loosely connected health and social service systems. Not all of these essential or beneficial services and supports would be classified as treatment. Some, like housing or employment services, address basic needs for health and wellness. Other services seek to promote health by improving the physical or social environment within the community.
Whether or not these services are called treatment, they all contribute to creating healthy communities and individuals. Treatment normally refers to the sub-set of services that provide direct supportive care to a person and family members experiencing problems associated with substance use. Some of these treatment services may address physical-health problems associated with substance use. Others may help a person deal with psychosocial issues, or address the substance use itself. Many of these services and supports may be delivered through primary care or other systems.
Some, however, are delivered by specialized substance-use treatment services. Treatment may happen in a counsellor’s office, a coffee shop, a hospital or rehab centre, or on the street. Treatment services include such options as substitution therapy. In substitution therapy a person is provided with
Drugs that meet their need in a safer way
Counselling support to assist in changing beliefs or increasing motivation
Training in social and emotional skills
A host of other supports the individual finds helpful in managing their recovery
No matter what aspect of the problem they address, or what system they are delivered through, treatment services are designed to help people reduce the harm from substance use, manage their recovery and achieve lasting health and wellness.
Treatment success should be measured through improvements in the quality of life and health status of affected individuals. Decades of research have established a variety of treatment methods that are successful.
These treatments include both behavioural therapy and medication. Recovery from dependence can be a long process and often requires extended treatment. Lapses during the course of treatment are common and do not mean that treatment is not working. In fact, it is critical to acknowledge lapses, learn from them, and incorporate those lessons into the treatment process. To be most effective, treatment must be readily available and customized to individual needs. It must also be part of an overall plan that addresses associated medical, psychological, vocational, legal, and other needs.
Getting help for a substance-use problem need not be scary. If you believe that you have a problem with substance use, it is important to recognize that you are not alone. There are millions of people across North America dealing with substance-use issues, many successfully.
It is important to understand that you can get help at any point along the way. The sooner you address your problems, the sooner you can create the life that you really want. Some important steps that you can take if you have a problem with substance use include:
Be honest with yourself. You know deep down on some level that your use is a problem. It is time to be direct with yourself about this, so that you can address your needs head-on. The sooner you do, the easier it will be.
Challenge your fears. It is easy to believe that something is “wrong” with you, or that you are somehow weak, inadequate or sick because of your problems with substance use. These myths are not true. People use alcohol and other drugs in an attempt to deal with a wide range of issues. It is important for you to discover why you use and address the underlying issues.
Talk to someone about your problems and fears. You may want to involve someone close to you with your healing process, for additional support. This could be a spouse, friend, or family member. Just sharing your issues with someone you trust can make it much easier to reach out for additional support.
Reach out and get help. There are a variety of resources and services available for people wanting help with a substance-use problem. You can find out what kind of help is available from your doctor, clergy or an employee assistance program (EAP). Therapists, community health agencies and alcohol and other drug treatment programs also provide valuable services. Additional resource information can be found at the end of this article.
When choosing a program or service provider to help you with your substance-use, it may be useful to look for situations and approaches that:
Cultivate realistic hope
Provide genuine acceptance and empowering support
Have self-directed change as their longer term goal
Another point to consider when choosing services is to look for providers that have experience dealing with circumstances like yours, and that are open to honest feedback about their approach. It has been shown that the best service providers are those who adjust their approaches based on client feedback.
Centre for Addictions Research of BC has a variety of resources at www.carbc.ca. Alcohol Reality Check (alcoholreality.ca) can help you figure out if you drink too much, or if your drinking habits are unhealthy and put you at risk of harm or becoming dependent.
Problem Substance Use Workbook: A self-paced workbook to guide readers through the process of understanding more about the impacts of problem alcohol or drug use behaviour and treatments. Also includes strategies on becoming more active in the recovery process at www.heretohelp.bc.ca.
HeretoHelp provides information on substance use and mental health issues. Go to www.heretohelp.bc.ca for more information.
The Alcohol and Drug Information and Referral Service is a telephone helpline available 24 hours per day, 7 days per week. Referrals available to specialized addiction services, and also to a variety of community based resources. It's available toll-free in BC at 1-800-663-1441 or at 604-660-9382 in the Lower Mainland.